Healthcare Provider Details

I. General information

NPI: 1871987776
Provider Name (Legal Business Name): ADAM M HEILALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 01/19/2024
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PARK CENTER CT.
TOLEDO OH
43615
US

IV. Provider business mailing address

5757 PARK CENTER CT.
TOLEDO OH
43615
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-4064
  • Fax: 419-472-2772
Mailing address:
  • Phone: 419-474-4064
  • Fax: 419-472-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.141748
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: